Closure.org Blog

By Dr. Jonathan Weinkle

The longer I discuss end-of-life, the more stories I hear, the more nuanced my view becomes.  Last month I facilitated a fascinating discussion that was meant to open an honest conversation about death and dying, to break down what I often call the Brighton Beach Memoirs approach to death – that is, whispering the word out of fear that, if we say it out loud it might happen to us.

The discussion ended with a personal story from one of the participants who was dying – her words, and her doctors – of a liver abscess two years prior, only to come back “escaped to tell thee” like one of the messengers coming to Job.  What had saved her was a surgery that had one chance in a hundred of succeeding, and who knows what chance of leaving her dead on the operating table.  Why was she undergoing the surgery?  Her daughter insisted that, “If she’s going to die anyway, why don’t you operate?  What have you got to lose?”
Sounds like anathema to the usual message of “caring before curing,” doesn’t it?  Yet it is hard to argue with the outcome of this previously dying woman who walked into the room under her own power, sat attentively in a lecture and discussion for an hour, and chose this moment at the waning of our hour to articulately tell the story of how reports of her death had been greatly exaggerated.

There are all sorts of conclusions one could draw about this being a miracle (“What have I done that was so special?” she asked me, rhetorically, afterward), or about never giving up (on that point of view, you already have my opinion).  I have said before that we have a right to hope for miracles, not to expect them.  I draw a different conclusion.

Look carefully at what her daughter said: “If she’s dying anyway . . .”  Eyes wide open, knowing the likely outcome, she took a chance, the only one she had, to bring a woman previously well back from death’s door.  She was responsible for the decision, and that is the decision she made.  I can’t fault that.

I can fault the system that makes these kinds of seemingly heroic decisions routinely, with patients who have far less understanding of how close they are to death, and with far lower chances of “success” (let alone the kind of success this woman achieved).  I can also fault the system that, mysteriously, is far more willing to do death-defying operations on the dying patient than to provide her with pain control or sedation to lessen her agony.  “If she’s going to die anyway,” I might say, “why don’t you provide her with some comfort?  What have you got to lose?”  And I can fault the system that has such a hard time saying the words, “She’s going to die,” anyway.